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ROOT CANAL
Effective

TREATMENT
Use of CERKAMED products for
comprehensive root canal treatment
Effective root canal treatment
how to use well the best new products for root canal preparation
and treatment.

Although there are many verified endodontic methods and techniques, none of these methods is recog-
nized to be the best. Nevertheless the hereunder rules are the existing procedures applied for root canal
preparation:
Precise drainage and widening of the root canal
Copious rinsing with antibacterial products
Removal of the smear layer and revealing the dentinal tubuli orifices
Hermetic root canal filling
The above procedures are achieved by the use of appropriate dental products which improve the treatment most effectively.
Failures in endodontic treatment are mostly caused by the bacteria left in the root canal, due to inaccurate cleansing and
filling.
The latest scientific studies shows that the use of dental tools and physiological saline allows to remove bacteria only in 50%
of cases. Usage of the irrigants like NaOCl and CHX increases the result to 80%.
Antibacterial properties of the irrigants might increase after application of substances removing the smear layer from the walls
of the root canal (EDTA, citric acid).
Precise cleansing of root canals and removing the germs enable hermetic root canal filling and also ensure full success in root
canal treatment.

I Single visit root canal treatment

Nowadays, many authors recommend single visit root canal treatment. It is a perfect solution provided that the doctor has
as much time as required and arisen inflammatory do not cause exudation from the root canal.

1. The treated tooth should be isolated from the oral cavity by rubber dam. The tooth cavity should be opened by means of any dental bur
that would allow to gain access to the root canals. Content of the cavity must be removed by means of any sterile bur and dental excavator.
2. After removing dead or inflamed pulp tissues from the tooth cavity, it is required to rinse it with solution of sodium hypochlorite
– CHLORAXID.

In case of endodontic re-treatment when root canals were filled with gutta-percha, it
is necessary to remove it by means of the product called EUCALYPTOL.
It is natural Eucalyptus oil which improve the efficiency of gutta-percha removal.
It is sufficient to insert a few drops of oil into the root canal and remove gutta-percha
that becomes soft and easy for removing.

3. Next the tooth chamber should be filled

with the product for root canal drainage like
ENDO PREP gel, ENDO PREP cream or ENDO-
SOLution. Insert carefully preparation into
the canal by means of any dental tool. The
first tool shouldn’t be introduced deeper than
half the canal’s length.

CERKAMED products used for drainage of the root canals

contain EDTA which main function is softening the tissue
through chelating process of calcium ions. These products
are available in gel ENDO PREP gel, in cream with urea
peroxide ENDO PREP cream, and in liquid ENDO-SOLution.
All of them are interchangeable.

ENDO PREP in gel apart from its active substance (EDTA) contains lubricants enabling easy introduction of the dental tool into the canal and
preventing its breakage.

ENDO PREP cream contains additionally urea peroxide which together with NaOCl makes the bubbling effect and the self-cleaning of the
root canal.
 ENDO-SOLution in liquid form is characterized by very good penetration and fast reaction
time on the tissues. This product enriched by surfacants (ENDO-SOLution Premium) helps
in removing the smear layer with its contaminants from dentinal tubules even of the smallest
diameter. Surfacants, content of this product, enables easier penetration of the liquid into the
narrow fissures of small tubules.

4. After initial drainage of the root canal it is required to rinse the canal once
again with CHLORAXiD in order to remove debris of tissue outside.

Actions of canal drainage and rinsing should be repeated a few times

considering not to reach root apex of the tooth (the possibility of pushing
the content of the canal through the tooth apex and infecting the periapical
tissues is reduced).

ENDO PREP gel (or ENDO-SOLution) is recommended to be used with the

first two or three sizes of dental tools, then preparation of the root canal
should be carried out without EDTA.
These products should not be left in the canal because it could lead to its
excessive softening.

5. At this stage mechanical widening of the canal should be complemented by its copious rinsing. For such purpose, it is
recommended to use antibacterial products CHLORAXiD and GLUCO CHeX 2%. Each root canal should be rinsed copiously
and simultaneously with physiological saline. Product GLUCO CHeX 2% contains chlorhexidine gluconate which is highly
efficient against bacterial strain immune to NaOCl. That is why these two products should be used as complementary in the
process of root canal rinsing.
While rinsing root canals, it is compulsory to remember to rinse physiological saline between
rinsing with these two solutions to avoid mixing them in root canal because it may cause precipi-
tating a tawny deposit which is difficult for removal.
Product GLUCO CHeX 2% gel thanks to its creamy consistency is simply for application
to the canal and easy for rinsing out. Lubricants contained in the product simplifies
introduction of the tool into the canal.

6. For removal of the smear layer and revealing the dentinal tubuli orifices in process of rinsing
the root canal, it is recommended to use Citric Acid 40%, walls of the canal after removing the
smear layer when Citric Acid 40% applied

pic. I pic. II

Wall of the canal after applying EDTA All the dentine tubuli orifices are open
15%, some of the dentinal tubuli orifices and smear layer is completely removed.
stay still closed. This product with concentration of 30-
40% removes successfully smear layer
remains.
7. In the last stage of root canal preparation it is recommended to rinse the canal with
sodium hypochlorite (CHLORAXiD) at concentration from 2% to 5,25% and chlorhexidine
(GLUCO CheX 2%) at concentration of 2% in alternate use with physiological saline in order
to remove bacterial flora from dentine tubules. Root canal preparation should be finished by
its rinsing with the product CANAL CLEAN. Its short evaporation time accelerates drying the
root canal. However, the canal can also be dried by means of paper points.

The root canal treated this way can be now precisely and hermetically filled. By this, efficiency of the treatment is increased, and the risk of
complications is minimized. Successful root canal treatment can be achieved by removing most of bacteria contained in smear layer and fill
dentine tubules.
 Two-visit root canal treatment
II There are situations when it is impossible to finish the treat-
ment during the first visit e.g. lack of time or persistence of
inflammation.
1. The first appointment is focused on precise preparation of the root canals
and applying the antibacterial product such as: CALCIPAST – ready for use,
non-hardening calcium hydroxide paste, or CALCIPAST +I – with iodoform
which makes the drying and bactericidal effect much stronger in case of
exudates in the root canal.
The very new product on the market is CALCIPAST FORTE which, apart from iodo-
form, contains chlorophenol that is even more effective in drying and disinfection
the root canal.
2. The second appointment is used for final filling. Removal of calcium hydroxide pastes does not cause any problem due to their non-
hardening formula. It is recommended to rinse out the paste CALCIPAST +I and CALCIPAST FORTE with the product CANAL CLEAN which
dissolves iodoform in the root canal.

CANAL CLEAN used as the last stage of rinsing the root canals accelerates drying of the root canal before its final filling.

After applying the product to the canal it is recommended to close securely the
tooth cavity using temporary filler Cerkamed TOTAL BLEND – light-cured material
based on calcium hydroxide. This hermetic filler, closing the access to the tooth cav-
ity, protects the canal from any contamination between the visits. TOTAL BLEND is
available in enamel shade (WHITE) and dentine shade (DENTINA) which makes it
possible to obtain proper cosmetic results.

The novelty is the product TOTAL BLEND BLUE in blue shadow, containing calcium
hydroxide. Thanks to its blue shadow, it is possible to locate precisely orifices of the
closed canals during next appointment.

III Multi-stage treatment

Multi-stage root canal therapy is appropriate for the treatment of
pathologic resorption and in order to rebuild the apex of roots.
In case of resorption it is recommended to rinse infected root canals with GLUCO CHeX
2% in liquid or in gel. Chlorhexidine gluconate contained in this product is highly
efficient against bacteria Enterococcus faecalis which may cause the abscesses.
Next, it is recommended to fill the system of root canals with temporary fillings
(for maximum 1 month), these are CALCIPAST +I or CALCIPAST FORTE which both
have anti-bacterial and drying effect on the root canal.
When the root apex area is damaged it is recommended to fill the canal with calcium
hydroxide paste CALCIPAST (for maximum 1-2 months, if necessary repeat the treat-
ment) which has strong odontotropic effect in stimulating and rebuilding the damaged
periapical tissues.
Besides this bactericidal activity CALCIPAST paste gives reinforced contrast in x-rays
which makes it possible to observe the evolution of tissues over time.

It is not difficult to remove calcium hydroxide paste CALCIPAST from the canal because of its non-hardening
formula. It is recommended to rinse it out with the product CANAL CLEAN which is very effective in dissolving
and removing preparations which contain iodoform.
CANAL CLEAN as the last rinsing agent contributes to dry the root canal in the most fastest and
effective method before its final filling.

ASK YOUR LOCAL DEALER ABOUT CERKAMED PRODUCTS

PPH CERKAMED
ul. Kwiatkowskiego 1, 37-450 Stalowa Wola, Polska
tel./fax: 15 842 35 85, tel. 15 841 64 33
www.cerkamed.com, e-mail: biuro@cerkamed.pl